Individual
BRIAN RANDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1140 BRICKYARD RD, 32B, SALT LAKE CITY, UT 84106-2565
(801) 474-9552
Mailing address
2263 S 2200 E, SALT LAKE CITY, UT 84109-1134
(801) 541-9504
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
4332
NV
122300000X
Dentist
54973
CA
122300000X
Dentist
Primary
9734638889221
UT
Other
Enumeration date
10/05/2006
Last updated
07/08/2007
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